Comparison of Efficacy and Safety of Different Second-line Therapies for Patients With Advanced Thymic Carcinoma.

AIMS: Thymic carcinoma (TC) is a rare form of highly invasive tumors. Currently, the standard first-line therapy involves paclitaxel plus carboplatin treatment, while the recommended regimen for second-line therapy remains uncertain. The purpose of this study is to explore the second-line mode of TC patients. MATERIALS AND METHODS: We evaluated the outcome of subjects with advanced TC between 2009 and 2023 in three medical centers, retrospectively. Tumor response was evaluated according to the Response Evaluation Criteria in Solid Tumors, version 1.1 (RECIST v1.1). Kaplan-Meier was used for calculating Progression-free survival (PFS) and overall survival (OS). The factors affecting survival in the real world were evaluated by Cox analysis. RESULTS: Totally 136 patients were included in this study, the median PFS (mPFS) for all subjects was 5.97 months, and the median OS (mOS) was 25.03 months. According to patient's treatment modes, they are divided into monotherapy (n = 95) and combination therapy (n = 41), PFS manifested the difference between two groups (5.17 vs. 9.00 months, P = 0.043). OS also indicated a significant distinction (22.50 vs. 38.00 months, P = 0.017). Furthermore, there was a significant difference in PFS between patients using immunotherapy combined with chemotherapy and those with antivascular therapy (8.57 vs. 13.10 months, P = 0.047). CONCLUSION: In the second-line therapy for advanced TC, the efficacy of combination therapy was better than monotherapy, especially for immunotherapy combined with antivascular therapy.

Derivation of no significant risk levels for three lower acrylates: Conclusions and recommendations from an expert panel.

A panel of toxicology, mode of action (MOA), and cancer risk assessment experts was engaged to derive no-significant-risk-levels (NSRLs) for three lower acrylates: methyl acrylate (MA), ethyl acrylate (EA), and 2-ethylhexyl acrylate (2EHA) using the best available science, data, and methods. The review was structured as a five-round, modified Delphi format, a systematic process for collecting independent and deliberative input from panel members, and it included several procedural elements to reduce potential sources of bias and groupthink. Input from the panel for key decisions in the dose-response assessments resulted in NSRL values of 530 µg/day (330-800 µg/day), 640 µg/day (280-670 µg/day), and 1700 µg/day (1300-2700 µg/day) for MA, EA, and 2EHA, respectively. Novel to this approach were the use of nonneoplastic lesions reported at point of contact where tumors have been reported in laboratory rodents, along with nonlinear extrapolation to low doses (uncertainty factor approach) based upon panel recommendations. Confidence in these values is considered medium to high for exposures applied to the routes of exposure tested (inhalation for MA and EA, dermal for 2EHA), but confidence is considered lower when applied to other routes of exposure.

Relationships between diabetic nephropathy and insulin resistance, inflammation, Trx, Txnip, CysC and serum complement levels.

OBJECTIVE: To investigate the relationships between diabetic nephropathy (DN) and insulin resistance, inflammation, thioredoxin (Trx), thioredoxin-interacting protein (Txnip), Cystatin C (CysC) and serum complement levels. PATIENTS AND METHODS: A total of 119 patients with type 2 diabetes mellitus (T2DM) treated in the Endocrinology Department of our hospital from January 2017 to December 2017 were enrolled as the experiment group, while 30 healthy volunteers were selected as the control group. The expression levels of inflammatory factors, Trx, Txnip, CysC and serum complements in every subject were detected. In addition, the type 2 diabetic nephropathy rat model was established via high-fat diet and injection of low-dose streptozotocin. Blood glucose, insulin resistance indexes and 24h-urinary albumin excretion were measured, and the histomorphological characteristics of the kidney in animals were observed. RESULTS: In clinical subjects, Trx level was notably lower in the simple DM group, early DN group and clinical DN group in comparison with that in the control group. The levels of Txnip and CysC in the simple DM group, early DN group and clinical DN group were remarkably higher than those in the control group. Moreover, the expression levels of TNF-α and IL-6 in the clinical DN group were significantly elevated compared with those in the simple DM group and early DN group. In addition, C1q expression in the clinical DN group was higher than that in the simple DM group and early DN group. In model rats, HOMA-IR was distinctly higher in the DM group and DN group than that in the control group. The ratio of kidney weight to body weight (KW/BW) was evidently higher in the DN group in comparison with that in the control group and DM group. CONCLUSIONS: Insulin resistance, inflammatory factors, and levels of Trx, Txnip, CysC and serum complement C1q are related to the progression of DM.

[Clinical analysis of mediastinal lymph node dissection through sternotomy approach in the treatment of papillary thyroid carcinoma with mediastinal lymph node metastasis].

Objective: To investigate the rule of mediastinal lymph node metastasis of papillary thyroid carcinoma and the application of therapeutic mediastinal lymph node dissection through the sternotomy approach in the treatment of mediastinal lymph node metastasis of papillary thyroid carcinoma. Methods: All cases of papillary thyroid carcinoma with mediastinal lymph node metastasis treated through sternotomy cooperated by thoracic surgeons and head and neck surgeons from January 2006 to January 2017 in Cancer Hospital of Chinese Academy of Medical Sciences were included in this study. The distribution, metastasis rate, metastasis degree, surgical method, surgical complications and postoperative survival of patients with mediastinal lymph node metastasis were retrospectively analyzed. Results: A total of 31 patients (16 males and 15 females) with papillary thyroid cancer with mediastinal lymph node metastasis, with a median age of 46 (19-65) years, were enrolled in the group. Partial upper sternotomy was used in 28 cases, and total sternotomy was used in 3 cases. The mediastinal lymph nodes of papillary thyroid carcinoma metastasized farthest to the station 6, and the lymph node metastasis rate of each group from high to low was: 2R (61%), 1R (39%), 3A (39%), 1L (16%), 2L (10%), 4R (10%), 5 (3%) and 6 (3%). No metastasis was observed in station 3P, 4L and 7. In addition, the degree of lymph node metastasis at station 2R was the highest, reaching 35% (77/219). Extra-nodal invasion of mediastinal metastatic lymph nodes in thyroid papillary carcinoma is common (23%), easily fuses into masses (23%) and invades peripheral vascular nerves (26%). Up to 29% of blood transfusions are required during or after surgery due to oozing or bleeding (9/31). The 1-, 3-, 5-and 10-year survival rates of patients undergoing surgical treatment were 94%, 94%, 87% and 81%, respectively. Conclusion: Papillary thyroid carcinoma can metastasize to almost all mediastinal lymph nodes except station 3P, 4L and 7. Radical mediastinal lymph node dissection through sternotomy is an effective method for the treatment of mediastinal lymph node metastasis of thyroid papillary carcinoma.

Hypoxic preconditioning BMSCs-exosomes inhibit cardiomyocyte apoptosis after acute myocardial infarction by upregulating microRNA-24.

OBJECTIVE: To elucidate the regulatory effect of hypoxic preconditioning bone marrow mesenchymal stem cells (BMSCs)-exosomes on cardiomyocyte apoptosis in acute myocardial infarction (AMI) rats. MATERIALS AND METHODS: BMSCs-derived exosomes were extracted by Exoquick method. Expressions of exosome surface markers were determined by Western blot. The AMI model in rats was established by LAD ligation. Rats were randomly assigned into sham group, AMI group, AMI+H-exo group and AMI+N-exo group. MicroRNA-24 expression in rat myocardium was detected at different time points. Subsequently, hypoxic preconditioning or normoxic preconditioning BMSCs-exosomes were intramyocardially injected into rats. Infarct size was calculated through TTC (triphenyltetrazolium chloride) staining. Cardiomyocyte apoptosis was accessed with Terminal Deoxynucleotidyl Transferase dUTP Nick-end Labeling (TUNEL). Heart function of AMI rats was evaluated by echocardiography. Protein expressions of apoptotic genes in rat myocardium were detected by Western blot. RESULTS: The mRNA level of microRNA-24 was higher in H-exo group than N-exo group. Injection of hypoxic preconditioning BMSCs-exosomes markedly upregulated microRNA-24 level, reduced infarct size and improved cardiac function in AMI rats. Protein expressions of Bax, caspase-3 and cleaved-caspase-3 were downregulated by BMSCs-exosomes treatment. H9c2 cells showed upregulated microRNA-24 level and decreased apoptotic rate after incubation with hypoxic preconditioning BMSCs-exosomes. The above cellular performances were partially reversed by transfection of microRNA-24 inhibitor. CONCLUSIONS: Hypoxic preconditioning BMSCs-exosomes inhibit cardiomyocyte apoptosis in AMI rats by upregulating microRNA-24.

Association between computed tomography-detected calcification and thyroid carcinoma.

This study aimed to investigate the diagnostic value of calcification detected by computed tomography (CT) for the differentiation of benign and malignant thyroid nodules. This is a retrospective study of 930 consecutive patients (709 women, 221 men; mean age 51 years) with pathologically proven thyroid nodules. The characteristics of calcification on CT images were correlated with the pathological results. A total of 168 patients were pathologically diagnosed with thyroid carcinomas and 762 patients with benign thyroid nodules. Calcification was found in 231 cases (24.84%). The incidence of calcification was significantly higher in patients with thyroid carcinoma (52.38%) than in those with benign nodules (18.77%; P < 0.001). Detection of calcification in diagnosing thyroid carcinoma had a sensitivity of 52.38% (88/168) and specificity of 81.23% (619/762). No significant difference was noticed in the incidence of microcalcification (≤ 2 mm) between malignant and benign nodules (P = 0.305). Calcification is more frequently found in thyroid carcinomas than benign nodules. CT detected-calcification may suggest malignant disease. Further confirmation of the suspected malignancy with fine-needle aspiration or surgery is still needed.

Disseminated Rhizopus microsporus infection following allogeneic hematopoietic stem cell transplantation in a child with severe aplastic anemia.

Disseminated Rhizopus microsporus infections are uncommon in children and are resistant to echinocandin and azole antifungal agents. We describe a child with severe aplastic anemia who developed disseminated R. microsporus infection following allogeneic hematopoietic stem cell transplantation. R. microsporus was identified microscopically in the hepatic drain culture and was confirmed on the basis of 18S rRNA and 28S rRNA sequence analyses. The patient was treated successfully with hepatic drainage and amphotericin B deoxycholate.

Transcription of promoter from the human APRIL gene regulated by Sp1 and NF-kB.

A proliferation-inducing ligand (APRIL) which stimulates the cell proliferation is abundantly expressed in colorectal cancer (CRC) tumors. In this report, the promoter region of the APRIL gene was determined and the major transcription factor was investigated for the first time. Deletion analysis of 5'-flanking region of the human APRIL gene and transient transfection revealed that a 538 bp region (from -1539 to -1001) was essential for promoter activation of the APRIL gene. The data from electrophoretic mobility shift assays (EMSA) indicated that the 538 bp promoter region was responsive to the specificity protein 1 (Sp1) and nuclear factor kappa B (NF-kB). Overexpression of Sp1 or NF-kB increased the activity of the APRIL promoter. Mithramycin A (inhibitor of Sp1) and Bay11-7082 (inhibitor of NF-kB) exhibited an inhibitory activity to APRIL promoter. Our results will benefit to the APRIL gene regulation investigation and contribute to discover new drug target for the APRIL gene therapy of CRC.

Increased expression of paxillin is found in human oesophageal squamous cell carcinoma: a tissue microarray study.

Oesophageal cancer is one of the most common cancers worldwide. Currently, the tumour, node, metastasis (TNM) staging system is the primary method for determining its extent and prognosis, however, data suggest this system does not predict prognosis accurately. Research has, therefore, concentrated on searching for specific biomarkers. Paxillin has been shown to play an important role in controlling cell spread and migration. Its over-expression is considered to correlate with the prognosis of some types of cancers, however, the relationship between paxillin expression and clinical outcome in oesophageal cancer has not been investigated. This study determined the expression of paxillin by immunohistochemistry on the tissue microarray of 100 oesophageal squamous cell cancer patients followed up for a mean of 55 months. Paxillin was over-expressed in tumours in 27/100 cases, compared with 6/100 cases for adjacent non-tumoural cells. No correlation occurred between expression of paxillin and overall patient survival, hence paxillin is not an effective prognostic marker in these patients.

High expression of nuclear factor of activated T cells in Chinese primary non-small cell lung cancer tissues.

PURPOSE: Nuclear factor of activated T cells (NFAT) has been reported to be involved in the development of various types of cancer including adenocarcinoma of the breast. This research was the first to investigate NFAT protein expression in primary non-small cell lung cancer (NSCLC) tissues from Chinese patients. METHODS: NFAT protein expression was determined in 130 surgically resected primary NSCLC and matched normal tissues by immunohistochemical analysis. The association between NFAT expression and clinical categorical variables was further analyzed with the SPSS software. RESULTS: We found that NFAT expression was much higher in 85 tumor tissues (65.4%) and lower in 45 tumor tissues (34.6%) compared with the matched normal tissues. Further statistical analysis by the chi-square test showed that high expression of NFAT proteins was significantly associated with tumor differentiation (p=0.045), invasion (p=0.031), histology (p<0.0001), tumor size (p=0.038) and cigarette smoking history (p=0.024). However, there was no correlation between the expression of NFAT proteins and pTNM classification, and no difference in 5-year survival rate between patients with high or low expression of NFAT proteins. Multivariate logistic regression analysis for the correlation between NFAT protein expression levels and various characteristics showed a significant association with histology (p=0.008, OR=0.273). CONCLUSION: Our results revealed that high NFAT expression was present in Chinese NSCLCs and that NFAT expression might be involved in the process of human lung cancer development.

Sulfatide-tenascin interaction mediates binding to the extracellular matrix and endocytic uptake of liposomes in glioma cells.

Tenascin-C is an extracellular matrix glycoprotein, whose expression is highly restricted in normal adult tissues, but markedly up-regulated in a range of tumors, and therefore serves as a potential receptor for targeted anticancer drug or gene delivery. We describe here a liposomal carrier system in which the targeting ligand is sulfatide. Experiments with tenascin-C-expressing glioma cells demonstrated that binding of liposomes to the extracellular matrix relied essentially on the sulfatide-tenascin-C interaction. Following binding to the extracellular matrix, the sulfatide-containing liposomes were internalized via both caveolae/lipid raft- and clathrin-dependent pathways, which would ensure direct cytoplasmic release of the cargoes carried in the liposomes. Such natural lipid-guided intracellular delivery targeting at the extracellular matrix glycoproteins of tumor cells thus opens a new direction for development of more effective anticancer chemotherapeutics in future.

Surgical treatment for upper or middle esophageal carcinoma occurring after gastrectomy: a study of 52 cases.

Fifty-two patients presenting with upper or middle esophageal carcinoma after gastrectomy between 1980 and 2003 were analyzed retrospectively. Among them, there were five cases of total gastrectomy, six cases of proximal partial gastrectomy and 41 cases of distal subtotal gastrectomy. The interval between gastrectomy and the diagnosis of esophageal carcinoma ranged from 2 to 22 years. Surgical procedures included resection of the esophageal lesion with esophageal replacement using non-reversed or reversed gastric tubes (2 and 3 cases respectively), and short or long segment colon (5 and 40 cases respectively); two cases underwent a palliative procedure (jejunostomy). Complications included cervical anastomotic leaks (3 cases), pulmonary infection (3 cases), atelectasis (2 cases) and cordis arrhythmia (5 cases), all of which responded to treatment. In our group, resection of the esophageal lesions and reconstruction of the esophagus was performed in 45 cases (86.5%), exclusion and bypass procedure of esophageal carcinoma and following radiotherapy and chemotherapy in four (7.7%), eternal jejunostomy for intestinal nutrition in two (3.9%) and death occurred in one case (1.9%) due to multiple organ dysfunction syndrome (MODS). Esophageal resection combined with lymph node dissection is indicated for the treatment of upper or middle esophageal carcinoma following gastrectomy. While esophageal substitutes can include non-reversed or reversed gastric tubes as well as short or long segment colon interpositions, we usually recommend the use of colon interposition. The 1-, 3- and 5-year survival rate of cases with resection of the esophageal lesions and reconstruction of the esophagus was 84.6%, 57.7% and 26.7% respectively.

Investigation on the rheological properties of hepatocellular carcinoma cells and their relevance to cytoskeleton structure.

OBJECTIVE: To investigate the relevance of the rheological properties, i.e., viscoelasticities and adhesion to basement membrane components coated surface, of both hepatocytes and hepatocellular carcinoma (HCC) cells to the cytoskeleton structure. METHODS: Micropipette aspiration technique was adopted to measure viscoelastic coefficients and adhesion forces to 2 microg/ml collagen IV/1.25 microg/ml laminin coated surface of the cells. Two kinds of cytoskeleton perturbing agents, colchicine and cytochalasin D, were used to treat both HCC cells and hepatocytes and the effects of these treatments on cell viscoelastic coefficients and cell adhesion forces were investigated. RESULTS: Upon treatment of cells with colchicine in a concentration range of 1 to 60 mg/L, the elastic coefficients, especially the first elastic coefficient K1, and adhesion forces of hepatocytes generally tended to increase or increased significantly while, in contrast, viscoelastic coefficients and adhesion forces of HCC cells decreased obviously. Upon treatment of cells with cytochalasin D in a concentration range of 0.25-5.00 mg/L, viscoelastic coefficients of both hepatocytes and HCC cells decreased uniformly, with a larger magnitude for the decrease in elastic coefficients and adhesion forces of HCC cells than for those of hepatocytes. Adhesion forces of hepatocytes and HCC cells onto collagen IV/laminin coated surface varied similarly as viscoelastic coefficients under the action of the cytoskeleton perturbing agents. A significant positive correlation existed between changes of HCC cell adhesion forces on collagen IV/laminin coated surfaces and those of cell elastic coefficients (P<0.01). CONCLUSIONS: The effects of cochicine and cytochalasin D on rheological properties of HCC cells differed significantly either in ways or extents from those on rheological properties of hepatocytes. These results might reflect the difference in the state of cytoskeleton structure and function among these two kinds of cells.

Aberrant cervical carotid artery.

Aberrant cervical carotid artery is an uncommon anomaly. Because this anomaly can lie in close proximity to the midline of the posterior part of the pharynx, it poses a significant risk during both major pharyngeal tumor resection and less extensive procedures such as tonsillectomy, adenoidectomy and palatopharyngoplasty. Five cases of aberrant cervical carotid artery were encountered and diagnosed using computerized tomography. In all five cases, the anomalous finding did not correlate with the presenting symptoms. Computerized tomographic images of these cases are provided. A review of the literature and the embryology of the aberrant carotid artery are presented. Awareness of the anomaly by radiologists and surgeons is essential to avoid accidental injury to the vessel during surgery.

Cavernous sinus gas.

Gas within the cavernous sinus is an unusual finding. We report three patients who demonstrated gas in the cavernous sinus on computerized tomography (CT). The clinical information of these patients was reviewed for the possible source of the gas and the symptoms induced by the gas. Cavernous sinus gas was seen in two patients with sphenoid sinus fracture and in one patient after intravenous fluid infusion. None of the patients had symptoms referable to the cavernous sinus gas, but one patient had a grave prognosis due to trauma. Identification of cavernous sinus gas on CT and correlation with the clinical information is mandatory for further management.

Fat in the cerebral falx.

BACKGROUND: Fat within the cerebral falx is commonly encountered in our daily practice but has never been characterized and reported. The purpose of this study was to determine the incidence of fat within the cerebral falx and to identify its clinical features. METHODS: The cerebral falx was prospectively imaged in 1,570 consecutive brain computed tomographic scans and its features characterized. Cerebral magnetic resonance imaging was done in some patients. RESULTS: Of the 1,570 cases studied, 115 revealed a small amount of fat in the cerebral falx. This fat had a purely negative Hounsfield value. It produced a high signal on both T1- and T2-weighted magnetic resonance images. There was no calcified component. The fat was seen most commonly in aged patients. No related symptoms were noted. CONCLUSIONS: Among the patients studied, fat in the cerebral falx had an incidence of 7.3%. It is an incidental finding in adults and requires no further evaluation or treatment.

[Susceptibility to lung cancer in Chinese is associated with genetic polymorphism in cytochrome P4502E1].

OBJECTIVE: To investigate the genetic polymorphism of cytochrome P4502E1 (CYP2E1) as a susceptibility factor for lung cancer in Chinese population. METHODS: The genotype frequencies of RsaI restriction fragment length polymorphisms were analyzed in 92 lung cancer cases and 137 frequency-matched normal controls. RESULTS: The CYP2E1 c1/c1 genotype was found in 72.8% of lung cancer cases, which was significantly higher (P < 0.01) than that in controls (54.7%). By multivariate analysis, this genotype was found to be associated with a 2.5-fold increased risk of lung cancer (adjusted OR 2.5, 95% CI 1.8-3.8). Stratified analysis suggested an interaction between CYP2E1 c1/c1 genotype and cigarette smoking. The odds ratio (OR) for the CYP2E1 c1/c1 genotype, cigarette smoking and both factors combined was 3.9 (95% CI 1.1-15.2), 4.1 (95% CI 1.1-15.9) and 7.9 (95% CI 2.4-29.4), respectively. The interaction between CYP2E1 c1/c1 genotype and pack-years of cigarette smoking followed the same pattern, with a markedly increased risk in the heaviest smokers. CONCLUSION: The CYP2E1 c1/c1 genotype is a susceptibility factor for development of lung cancer in Chinese and there is an apparent gene-environment interaction between the susceptible genotype and cigarette smoking.

Evidence for a role of chloroethylaziridine in the cytotoxicity of cyclophosphamide.

UNLABELLED: A number of investigators have observed that the use of 4-hydroperoxycyclophosphamide (4-HC) in multiwell plate cytotoxicity assays can be associated with toxicity to cells in wells that contain no drug. Previous reports have implicated diffusion of 4-HC decomposition products, and acrolein in particular, as the active species. PURPOSE: The purpose of this study was to elucidate the species responsible for the airborne cytotoxicity of 4-HC, and to devise ways to minimize such effects in chemosensitivity assays. METHODS: To this end, analogues of 4-HC were synthesized to identify the contributions of individual cyclophosphamide metabolites to cytotoxicity. The analogues were then tested for activity against three human breast tumor cell lines (including a line resistant to 4-HC), and one non-small-cell lung carcinoma line. Cytotoxicity was evaluated by assays that quantitate cellular metabolism and nucleic acid content. RESULTS: Didechloro-4-hydroperoxycyclophosphamide, a compound that generates acrolein and a nontoxic analogue of phosphoramide mustard, gave no cross-well toxicity. In contrast, a significant neighboring well effect was observed with phenylketophosphamide, a compound that generates phosphoramide mustard but not acrolein. Addition of authentic chloroethylaziridine reproduced the airborne toxicity patterns generated by 4-HC and phenylketophosphamide. Increasing the buffering capacity of the growth medium and sealing the microtiter plates prevented airborne cytotoxicity. CONCLUSION: Since it is unlikely that phosphoramide mustard is volatile, these findings implicate chloroethylaziridine rather than acrolein as the volatile metabolite of 4-HC that is responsible for airborne cytotoxicity. The fact that chloroethylaziridine is generated in amounts sufficient to volatilize, diffuse across wells and cause cytotoxicity indicates that it is an important component in the overall cytotoxicity of 4-HC in vitro. Furthermore, these findings suggest that chloroethylaziridine may also contribute to the toxicity of cyclophosphamide in vivo.

Intraoperative neurosurgical ultrasonography.

BACKGROUND: Ultrasound scanning is a well-established means of evaluating intracranial structures in infants and children with open fontanelles. However, it remains underutilized in neurosurgical operations. We present our experience with the intraoperative use of realtime ultrasonography during 36 neurosurgical procedures. METHODS: Thirty-six intraoperative ultrasonography (IOUS) procedures were performed over the past two years. Thirty-two patients had intracranial lesions and four had intraspinal tumors. A real-time scanner equipped with a 5 MHz and a 7.5 MHz transducer was used during surgery. RESULTS: IOUS worked well, regardless of the location of the craniotomy site. It was useful in localizing and characterizing intracranial and intraspinal masses, assuring the completeness of tumor removal (22 cases), proper positioning of ventricular shunt catheters (5 cases), guiding and confirming the decompression of cysts or abscesses (3 cases) and real time monitoring of surgical complications (36 cases). CONCLUSIONS: IOUS can be helpful in defining intracranial and intraspinal lesions as well as normal architecture. It shortens the operative time and decreases the surgical morbidity. The expertise of the physician with sonographic equipment facilitates its accurate and expedient intraoperative neurosurgical application.

Intracranial pathology: comparison of intraoperative ultrasonography with computerized tomography and magnetic resonance imaging.

BACKGROUND: High-resolution, real time, intraoperative ultrasonography (IOUS) has been used in a number of cases in our neurosurgical department to identify, localize and characterize intracranial abnormalities. We compare the images of IOUS with those of computerized tomography (CT) and magnetic resonance imaging (MRI) in order to enhance our experience and confidence. METHODS: IOUS images were compared with preoperative CT scans and/or MRIs in 30 intracranial masses. Tumor size and margin, echogenicity and edema were the features compared. RESULTS: The images of IOUS, CT and MRI correlated closely except for images of primary gliomas. IOUS was more effective than CT and MRI in delineating the extent of a glioma, determining whether a lesion was cystic, with or without septation, or solid and in guiding surgical procedures. The contrast enhancement available with CT and MRI could not be demonstrated with IOUS. CONCLUSIONS: IOUS provides exquisite detail of intracranial pathology as well as, or even better than, CT and MRI. Its application should be emphasized to minimize damage of normal brain tissue and increase the completeness of tumor resection.